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DR.
Recently you suggested that a patient sufferring from scalp itch caused by minoxidil should be cautious about using topical steroids to relieve the itching sensation. I have been prescribed the topical steroid clobetesol to relieve itching I have suffered from the same symptoms, what are the potetial negative side effects that I should be concerned about? Thanks.

Chronic use of steroids can cause hair loss and if the steroids are in high enough quantity and taken long enough, it can, of course, impact the adrenal glands. This is why potent corticosteroids like clobetasol should not be used for extended periods of time (no longer than 2 weeks is recommended in most cases).

Interestingly, excessive hair growth is reported as a possible rare side effect from clobetasol (depending on the variation used), but itchy and dry skin seems to be common. The list can be found here.

Dr. Rassman,

I appreciate you answering the last few questions I’ve sent over. But to follow up, when I see hair shedding as a result of minoxidil and/or finasteride, can I read anything into the quality of the hair that is shedding? Does it mean one thing if the hairs are long and dark as opposed to miniaturized and light?

I believe that you are reading too much into the shedding, but I have not examined shed hair so I really do not know what is happening. The shedding appears to be a shifting into another hair cycle, nothing more.

Dear Dr Rassman:

I’m a 27 year old who has long suffered from Fibrous Dysplasia (I’m not sure if you are familiar with this disease). Due to my ailment, I have incurred over 30 medical surgeries over my lifetime. My hair was thick up untl high school, and then it really began to thin. The only ancestors of mine that have been bald were only two of my great-grandfathers. I was wondering if all of the major surgery I have had would have caused my hair loss. Also, I have been on propecia since November of last year and am having some back surgery next week. Would the shock of surgery or the medications used cause my hair loss to increase? Also, because I may be missing a couple of days of propecia doses would this affect the progress of the drug in combating my hair loss?

I’m familiar with fibrous dysplasia (it is a very rare bone disease), but I do not know what surgery you have had or what medications you take. Your question is very general and it is not something I can give you an answer to in this format. You need to see a physician and have a complete history and examination.

In most cases, hair loss in men is caused by genetics. If you have an autoimmune disease like a form of a scarring alopecia, surgery done in these conditions can be dangerous and produce failures of the grafts and further scarring of the scalp. Any medical illness or surgery that is a stress to your body can cause hair loss (sometimes permanent). But to distinguish that from genetic causes is something that only a thorough examination with a physician can provide. You are looking for a cause and effect type of relationship and I really cannot help you with the limited information I have.

Hello. I’ve been trying to get pregnant with my second child and it’s taking a long time - went to fertility doc last year and all tests came back fine for me and husband - he put me on Femara to help me ovulate more efficiently - I was on it for 4 cycles but after the second cycle I started shedding hair like crazy and my face broke out awful - I’ve been off of it since last Dec but my hair and skin have not gotten back to normal - my ob/gyn ran bloodwork for hormones, thyroid, etc and all came back normal - do you have any idea why my hair is still shedding and not growing back normally - I never had a problem with my hair until I took the Femara - I’m just nervous that it did some permanent damage to me - I’m sure stress is not helping because of course now I’m stressing about the hair loss - please help if you can!! Thanks so much!

Alopecia (hair loss) is listed as an uncommon side effect with Femara, so it is known to some degree. In general, hormone manipulation can cause hair loss, particularly if there is some genetic trait that makes you vulnerable. It can take up to a year to wait to determine if the hair will return (just like hair loss with or after pregnancy). Good luck, but be patient.

I have been on propecia for about 6 months and it seems to have stopped my shedding. I read somewhere that Lexapro can cause hair loss. If i start taking Lexapro 10mg can it still cause hair loss even if i’m taking propecia?

The drugs that cause hair loss are not protected by taking Propecia. Keep in mind that Lexapro doesn’t cause hair loss for everyone taking it, but it is a possibility.

About 3 weeks ago, I was prescribed generic finasteride by a physician (and told to use Rogaine, as well), but after I experienced some side effects he suggested that I stop the finasteride.

Since that time, I’ve continued using Rogaine and have experienced an increase in shedding which, while expected, is still pretty unnerving. I still have full coverage of my scalp for the most part, but my concern is that I’m shedding what appear to be strong, dark hairs rather than light, miniaturized hairs.

Should the quality of the hair I’m losing be a concern or is this type of shedding normal? Also, is it possible for the Propecia to still be inducing shedding even though I only took it for 9 days and stopped about 2 weeks ago?

If / when the shedding occurs with either medication (minoxidil or finasteride), it usually lasts no more than 3 months, often less. Be patient, wait it out, and stay the course. I couldn’t tell you which medication is causing it, though.

Hi. My question is regrading accutane and hair loss. I took accutane when I was 15 at 40 mg for 6 months. I didn’t notice any hair loss at the time but a few years after I started noticing that the hair on the top of my head has been getting thin. Now at 23 my hairline has receeded somewhat particularly fast. I really don’t know what to think as I have been off of accutane for 8 years. I heard alot of people on the Internet talk about the effect it has on the hair. My question is could this hairloss be related to the accutane I took 8 years ago or could this be mpb?

I frankly can not tell you if you have a connection between drug-induced hair loss from years earlier or if you just have male pattern baldness from genetic causes. It is true that Accutane (isotretinoin) does seem to cause hair loss, but I can not comment on an 8 year gap between taking the drug and the appearance of the hair loss.

hello doctor.
i had been using minoxidil 5% and got very good results. 18 months back i stopped using it due to scaling. by the time i got control over the scaling, i had lost much of the hair on the crown. my doctor told me to use minox 5% not only on the hair lost crown but also on the entire top of the head including frontal area where i was not having any hair loss. i used it as per he told and the result was, i lost hair from all over the top including frontal area due to itching. i couldnt see any good results after using minoxidil 10% for 1 year but lost my frontal hairs too. 2 months back i stopped using minoxidil 10%.

i am not having any itching sensation now..what should i do now? my frontal hair is receding 1 inch every two weeks, the crown area is more and more visible now. do i have to undergo any tests? i lose around 500 hairs/day. do i have to use minoxidil 5% again? if so..then do i have to apply it on the new hair loss area ie, frontal part? do i have to massage the lotion to skin? please do help me doctor..!! please…!!

Without seeing you I can not comment on the 500 hairs per day you are losing. But at that loss rate, you will be fairly bald in 2-3 years, if it is really true. I can’t give you advice about which medications to use, but if your doctor told you to lose something that caused hair loss, go back to that doctor and talk to him/her. If not, I would see an expert physician to get a diagnosis and then a treatment that works (perhaps you can find a doctor in your area at ISHRS.org).

Hi Dr. Rassman,

I have followed the questions and your answers in regards to Somatropin or testosterone supplementation. I am 40 and have virtually stopped all hair loss since my late 20’s due to the medicines on the market. I have a doctor in NY who treats me for a bad lower back condition, and he recommends I use an hgh cream and a testosterone cream, we did a blood test and my T was quite low. The hgh would assist me in recovery. I discussed with him my concerns and my history, and he doesn’t feel I should have a problem with my hair. However, this is not his area of expertise. My question is, can I attempt to use 1 or both of these products and monitor my hair loss, and if its starts thinning simply stop using the creams. thank you

HGH can and often does accelerate hair loss in genetically prone individuals. There is risk here and you should take charge of your risks before you dive in. If your doctor prescribes a cream, I’m not going to tell you to cease using it, particularly if it is helping you recover. I can not advise you what to do in this situation.

Hi there, in the past 2 months I have noticed my hair thinning in my crown area. I am Caucasian male, 23 years old. Since then I ordered Propecia online (it’s not the generic kind) and have been using it for 3 weeks now. I did not go and see a doctor in person to get a prescription.

Now I am getting a little paranoid that my hair is falling out even more since I have been using Propecia. I feel like my hair is thinning all over. Could this just be a placebo effect and me just being overly anxious and paranoid? I mean is it safe to use Propecia or does it make your hair fall out if it is not needed or prescribed by the doctor? I do not have any of the side effects that are listed on their website. Could you please advise as to what to do? I just want to know that what I am taking is not harmful to my existing hair as I might have not needed Propecia in the first place but became paranoid that i was loosing hair in the crown area. Thank you.

The first question you should ask yourself is, “Am I sure I got real Propecia?” If you just bought a prescription medication from an online vendor without a doctor’s prescription or any verification, I wouldn’t necessarily put a whole lot of trust in it.

What I really want to know is, why are you treating yourself? You should never take a medication if it is not needed, and you should’ve been under a doctor’s care before treating yourself with prescription drugs. A doctor can tell you if the medication is right for you. You couldn’t really expect me to encourage or even condone your actions, could you? That being said, Propecia shedding is reported by some people.

Follow the many posts here on the drug Propecia (use the search), get the diagnosis of hair loss, find the presence of miniaturization, and on and on. I can not practice medicine on you over the internet and it sounds like you need to see a doctor.